Neuro-ophthalmology CE/CME ACCREDITED Watch Time: 49 mins

touchSATELLITE SYMPOSIUM Latest developments in neuromyelitis optica spectrum disorder: Diagnostics, treatments and patient-centred care

Three experts examine evidence-based approaches for early and accurate diagnosis, appropriate treatment selection and patient-centred care to mitigate the clinical burden of neuromyelitis optica spectrum disorder.

Watch Time: 02:55

Dr Dalia Rotstein opens the symposium and sets the scene for discussions on the latest developments in the diagnosis, treatment and management of NMOSD.

 
Watch Time: 08:43

Dr Eoin Flanagan discusses the characterization of NMOSD, and the latest evidence-based strategies to achieve timely and accurate diagnosis.

 
Watch Time: 03:19

Dr Dalia Rotstein poses questions from the live audience at the Consortium of Multiple Sclerosis Centers Annual Meeting 2023 to Dr Eoin Flanagan. To view audience questions, please view the downloadable slides.

 
Watch Time: 14:51

Dr Jeffrey Bennett reviews the latest efficacy and safety data on immunotherapies for NMOSD, and the factors influencing clinical decision making in daily practice.

 
Watch Time: 04:00

Dr Dalia Rotstein poses questions from the live audience at the Consortium of Multiple Sclerosis Centers Annual Meeting 2023 to Dr Jeffrey Bennett. To view audience questions, please view the downloadable slides.

 
Watch Time: 04:41

Dr Dalia Rotstein summarizes the wider clinical symptoms of NMOSD and multidisciplinary strategies to mitigate the burden of disease.

 
Watch Time: 10:28

In this interactive session, the panellists answer questions from the live audience at the Consortium of Multiple Sclerosis Centers Annual Meeting 2023 and provide their expert insights on how multidisciplinary, patient-centred strategies can be implemented to manage the burden of symptoms of NMOSD. To view audience questions, please view the downloadable slides.

 
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Overview & Learning Objectives
Overview

In this touchSATELLITE SYMPOSIUM activity, leading experts in neuromyelitis optica spectrum disorder (NMOSD) examine evidence-based approaches to achieve early and accurate diagnosis of NMOSD, leading to appropriate treatment selection. They explore the latest clinical data on current and emerging treatments, and discuss multidisciplinary strategies to mitigate the clinical burden of NMOSD and improve patient quality of life.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of neurologists, including neuroimmunologists; neuroradiologists; ophthalmologists, including neuro-ophthalmologists; and specialist neurology nurses involved in the management of NMOSD.

Disclosures

Faculty

Dr Dalia Rotstein discloses: Advisory board or panel fees from Alexion, Biogen, EMD Serono, Novartis, Roche and Sanofi. Grants/research support from Roche. Speaker’s bureau fees from Alexion, Biogen, EMD Serono, Novartis, Roche and Sanofi Aventis.  

Dr Eoin Flanagan discloses: Advisory board or panel fees from Alexion, Genentech, Horizon Therapeutics and UCB (All relationships terminated). Grants/research support from UCB.   

Dr Jeffery Bennett discloses: Advisory board or panel fees from Clene Nanomedicine, Genentech and Roche. Consultancy fees from AbbVie (relationship terminated), Alexion Pharmaceuticals, Antigenomycs (relationship terminated), BeiGene, Chugai Pharmaceutical, Genentech, Genzyme (relationship terminated), Horizon Therapeutics, Imcyse, Mitsubishi Tanabe Pharma, Reistone Biopharma, Roche and TG Therapeutics. Grants/research support from Alexion, Mallinckrodt Pharmaceuticals and Novartis. Other financial or material support from Aquaporumab. Speaker’s bureau fees from Alexion.

Content reviewer

Niraja S Suresh has no interests/relationships or affiliations to disclose in relation to this activity.

Touch Medical Directors

Adriano Boasso and Aniket Parikh have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 22 June 2023. Date credits expire: 22 June 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recall strategies that facilitate an early and accurate diagnosis of NMOSD
  • Describe how evidence from clinical trials investigating current and emerging treatments for NMOSD informs clinical decision making
  • Select individualized management plans for patients with NMOSD to reduce the patient-reported burden of symptoms
Faculty & Disclosures
Dr Dalia Rotstein

University of Toronto, ON, Canada

Dr Dalia Rotstein is a neurologist at St. Michael’s Hospital and an assistant professor at the University of Toronto, ON, Canada. Her research is focused on the epidemiology of multiple sclerosis and other demyelinating diseases in diverse populations, with the goal of promoting more inclusive care and equitable outcomes. read more

Dr Rotstein has a particular interest in the roles of sex, ethnicity, migration and Epstein-Barr virus infection in these conditions. She is the principal investigator for CANOPTICS, the first Canadian national prospective study to investigate adults with neuromyelitis optica spectrum disorders, myelin oligodendrocyte glycoprotein antibody-associated disease and other atypical demyelinating conditions.

Dr Dalia Rotstein discloses: Advisory board or panel fees from Alexion, Biogen, EMD Serono, Novartis, Roche and Sanofi. Grants/research support from Roche. Speaker’s bureau fees from Alexion, Biogen, EMD Serono, Novartis, Roche and Sanofi Aventis.  

Dr Eoin Flanagan

Mayo Clinic, Rochester, MN, USA

Dr Eoin Flanagan is a professor of neurology and consultant in the departments of Neurology and Laboratory Medicine and Pathology at the Mayo Clinic, Rochester, MN, USA. He completed his neurology residency and was awarded fellowships in neuroimmunology and a masters in clinical and translational science at the Mayo Clinic, Rochester. read more

Dr Flanagan works in the Center for Multiple Sclerosis and Autoimmune Neurology clinics and the Neuroimmunology Laboratory at the Mayo Clinic. His clinical expertise and research are focused on myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders, transverse myelitis and other myelopathies, autoimmune encephalitis, paraneoplastic neurologic disorders and multiple sclerosis. He is a principal investigator on a National Institutes of Health research project grant studying MOGAD, and was a member of the International MOGAD panel that devised its diagnostic criteria.

Dr Eoin Flanagan discloses: Advisory board or panel fees from Alexion, Genentech, Horizon Therapeutics and UCB (All relationships terminated). Grants/research support from UCB.  

Dr Jeffrey Bennett

University of Colorado, Aurora, CO, USA

Dr Jeffrey Bennett is the Gertrude Gilden professor for neurodegenerative disease research in the departments of Neurology and Ophthalmology at the University of Colorado (CU) School of Medicine, Aurora, CO, USA. He is also a faculty member of the programmes in immunology and neuroscience, and the Rocky Mountain MS Center at Anschutz Medical Campus, Aurora. read more

Dr Bennett directs basic, translational and clinical research programmes on neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), optic neuritis and myelin oligodendrocyte glycoprotein antibody-associated disease, and maintains active specialty practices in neuro-ophthalmology and neuroimmunology. He has received the Stephen Reingold Award from the National MS Society and the CU Experts Inventor of the Year Award.

Dr Bennett has been a leader in understanding the role of B cells in demyelinating disorders. Using single cell recombinant monoclonal antibody technology, his laboratory has probed the targets of the immune response in NMOSD and MS. His research in NMOSD has elucidated the pathogenicity of aquaporin-4 (AQP4) autoantibodies, identified B cell epitopes on AQP4 protein, and assisted in the development of novel antigen-specific therapies. He is widely published, and is a regular member of scientific review committees for the National Institutes of Health and the National MS Society.

Dr Jeffery Bennett discloses: Advisory board or panel fees from Clene Nanomedicine, Genentech and Roche. Consultancy fees from AbbVie (relationship terminated), Alexion Pharmaceuticals, Antigenomycs (relationship terminated), BeiGene, Chugai Pharmaceutical, Genentech, Genzyme (relationship terminated), Horizon Therapeutics, Imcyse, Mitsubishi Tanabe Pharma, Reistone Biopharma, Roche and TG Therapeutics. Grants/research support from Alexion, Mallinckrodt Pharmaceuticals and Novartis. Other financial or material support from Aquaporumab. Speaker’s bureau fees from Alexion.  

Downloads

View and download resources from this activity to support your learning and share with colleagues

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Question 1/5
Your 38-year-old female patient presents with acute diencephalic clinical syndrome (anorexia with substantial weight loss and hypothermia) over a 3-week period. Further testing confirms she has AQP4-IgG negative status. Which of the following additional clinical signs is needed to qualify for a diagnosis of AQP4-IgG seronegative NMOSD?

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder.
Correct

For the diagnosis of NMOSD in patients with negative or unknown AQP4-IgG status, international consensus–based diagnostic criteria require the following:1,2

  • Two or more of the six core clinical characteristics resulting from ≥1 clinical attacks, including ≥1 of the following:
    • Area postrema syndrome
    • Optic neuritis
    • Acute myelitis with LETM
  • Exclusion of alternative diagnoses

Abbreviations

AQP4-IgG, aquaporin-4 immunoglobulin G; LETM, longitudinally extensive transverse myelitis; NMOSD, neuromyelitis optica spectrum disorder.

References

  1. Wingerchuk DM, et al. Neurology. 2015;85:177–89.
  2. Wingerchuk DM, Lucchinetti CF. N Engl J Med. 2022;387:631–9.
Question 2/5
Approximately what proportion of patients with NMOSD are AQP4-IgG positive with cell-based assays?

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder.
Correct

Approximately 90% of patients with NMOSD are AQP4-IgG positive as determined by the latest cell-based assays.1,2

Abbreviations

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder.

References

  1. Hyun J-W, et al. Neurology. 2016;86:1772–9.
  2. Prain K, et al. Front Neurol. 2019;10:1028.
Question 3/5
Approximately what proportion of patients with AQP4-IgG-positive NMOSD were relapse-free at 3.7 years in the PREVENT open-label extension study (eculizumab monotherapy)?

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder.
Correct

In the PREVENT open-label extension study with eculizumab monotherapy (N=33), 96% of patients with AQP4-IgG-positive NMOSD were relapse-free at 3.7 years (cumulative probability Kaplan-Meier analysis: 0.962 [95% confidence interval: 0.757–0.994]).

Abbreviations

AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder.

Reference

Pittock SJ, et al. Mult Scler J. 2022;28:480–6.

Question 4/5
In the PREVENT open-label extension study with eculizumab monotherapy (N=33), 96% of patients with AQP4-IgG-positive NMOSD were relapse-free at 3.7 years (cumulative probability Kaplan-Meier analysis: 0.962 [95% confidence interval: 0.757–0.994]). Abbreviations AQP4-IgG, aquaporin-4 immunoglobulin G; NMOSD, neuromyelitis optica spectrum disorder. Reference Pittock SJ, et al. Mult Scler J. 2022;28:480–6.
Correct

According to the FDA-approved prescribing information, the most common adverse reactions (≥10% of patients treated with inebilizumab and greater than placebo) were urinary tract infection and arthralgia.

Abbreviation

FDA, US Food and Drug Administration.

Reference

FDA. Inebilizumab PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2020/761142s000lbl.pdf (accessed 28 April 2023).

Question 5/5
Based on data from Kim HJ, et al., presented at AAN 2022, which immunomodulatory therapy was associated with year-on-year improvement in pain scores?

ANN, American Academy of Neurology.
Correct

In the N-MOmentum study (NCT02200770), participants with moderate-to-severe pain (SF36-BPS <40) at baseline reported a year-on-year improvement from baseline in mean (95% confidence interval) SF36-BPS of 6.57 (4.75–8.38) points after 1 year, 7.08 (5.34–8.82) after 2 years and 7.96 (6.29–9.64) after 3 years.

Abbreviation

SF36-BPS, 36-Item Short-Form Survey Body Pain Subscore.

Reference

Kim HJ, et al. Neurology. 2022;98(18 Supplement):1569.

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